经皮自体骨髓移植治疗骨折不愈合的临床观察

目的：观察经皮自体骨髓移植治疗骨折不愈合的临床效果。方法：2001年6月至2007年12月,29例骨折不愈合采用经皮自体骨髓注射的方法治疗。男20例,女9例;年龄20～71岁,平均40岁。均为外伤性骨折,胫骨13例,股骨10例,肱骨3例,尺骨2例,桡骨1例,其中开放性11例。骨髓移植时所有患者经过手术内、外固定,髓内钉15例,钢板12例,外支架2例。病程6～12个月,平均8.5个月。骨不连类型：萎缩型26例,肥大型3例。所有病例予3次经皮自体骨髓注射,间隔1个月,骨髓注射量6～15ml。结果：29例全部获得随访,时间5～22个月,平均14个月。其中4例随访至第3次注射后3个月仍然未见明显骨痂形成,判定为治疗失败,改行自体植骨术（其中3例重新内固定）,随访结束。其余25例在3～8个月（平均4.5个月）内获得骨性愈合,到拆除固定时随访结束。结论：经皮自体骨髓移植是治疗骨折不愈合的有效手段,操作简单,经济安全。但是,稳定的内、外固定是自体骨髓移植的前提,骨缺损过多,骨折间隙〉5mm,骨不连且对线对位不良需要矫正者,不适宜采用该方法。

Clinical observation on percutaneous autologous bone marrow grafting for treatment of fracture nonunion

Objective: To observe the effectiveness of percutaneous bone marrow grafting for treatment of fractures nonunion. Methods: From June 2001 to December 2007,29 consecutive cases of fractures nonunion were treated with percutaneous autologous bone marrow grafting included 20 males and 9 females,ranging in age from 20 to 71 years,with an average of 40 years. All the cases were traumatic fractures involving 13 of tibia,10 of femur,3 of humerus,2 of ulna,1 of radius,11 cases of them were open fractures. All the cases were performed internal or external fixation before marrow grafting,intramedullary pin in 15 cases,plate in 12 cases,external fixator in 2 cases. The time from injury to therapy were from 6 to 12 months,with an average of 8.5 months. The type of nonunion included atrophic in 26 cases,hypertrophic in 3 cases. All the cases were performed 3 times injection,the interval was 1 month. According to the different fracture,the amount of bone marrow was from 6 to 15 ml. Results: All the 29 cases were followed-up for from 5 to 22 months with an average of 14 months. Four of them were not observed obvious callus after 3 months from the 3th injection,judged unsuccssful therapy,changed to perform autologous bone grafting (3 of them re-internal fixation),the follow-up ended. The other 25 cases obtained bone union during 3 to 8 months with an average of 4.5 months,the follow-up ended at the time of internal fixation removal. Conclusion: Percutaneous autologous bone marrow grafting is an effective,easy and economic therapy for fracture nonunion. But stable internal or external fixation is the premise. Excessive bone defect,the gap more than 5 mm and mal-align requiring rectification is not appropriate for this therapy.